Breast reconstruction with a pedicled TRAM flap.

Breast reconstruction with the pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains a useful option for most patients seeking autogenous tissue reconstruction. This article emphasizes aesthetic analysis of the opposite breast and tissue requirements as important determinants of the preoperative reconstructive plan and guides for specific procedure selection (unipedicle versus bipedicle). This article succinctly reviews the techniques and tips for flap elevation and inset, designed to produce consistent aesthetic outcomes with pedicled TRAM flap breast reconstruction.